Correction Of Residual Deformity Research Articles

Commentary on: Use of Himplant® for correction of residual deformity following prior treatment of Peyronie's disease: a case report.

Commentary on: Use of Himplant® for correction of residual deformity following prior treatment of Peyronie's disease: a case report.

Use of Himplant® for correction of residual deformity following prior treatment of peyronie's disease: a case series.

Over the years, numerous non-surgical and surgical treatment options have been explored for Peyronie's disease. Current options may result in incomplete correction of the deformity, which can be bothersome to the patient. This is a two-center case series of three patients who had previously undergone treatment for Peyronie's disease. Patient 1 underwent plication with extratunical grafting. Patient 2 underwent a series of Xiaflex® injections and then subsequent surgical plication for residual curvature. Patient 3 underwent a series of Xiaflex® injections. The Himplant® subcutaneous silicone penile prosthesis was placed in a standardized manner through a scrotal incision in all cases to mask residual penile deformities and enhance penile girth after Peyronie's disease treatment. Patients were contacted and asked 18 questions regarding satisfaction and erectile function with the responses recorded. This pilot study presents findings of high patient satisfaction, increases in flaccid penile length and girth, and an acceptable profile of adverse events following Himplant® placement. Based on our limited experience, we would consider offering Himplant® implantation when residual curvature is <40° and the penile indentation does not cause instability/buckling during penetrative sexual activity. Further research and larger studies are warranted to validate these findings and assess long-term outcomes and patient-reported satisfaction.

(174) Use of Penuma® for Correction of Residual Deformity following Previous Treatment of Peyronie’s disease: Case Series

Abstract Introduction Over the years, numerous treatment approaches have been explored for Peyronie's disease (PD) including non-surgical and surgical options. Nevertheless, the current options are largely insufficient in effectively correcting residual penile deformities after treatment. Objective To evaluate the efficacy of utilizing the subcutaneous silicone penile prosthesis (Penuma®) as a treatment modality for correcting residual penile deformity, including curvature and indentation, and providing penile girth enhancement post-PD treatment. Methods This is a two center case series of three patients who had previously undergone various treatments for PD. Detailed data about these patients were collected including their demographics, PD characteristics, previous treatments, and outcomes (see table). These patients previously had different treatments including non-surgical i.e. Xiaflex® and/or surgical options i.e. plication procedure. The placement of Penuma® subcutaneous silicone penile prosthesis was performed in a standardized manner across all cases. Follow-up evaluations were conducted to assess the effectiveness of the procedure and any associated complications. Results The main findings of the study revealed successful correction of residual penile deformity (curvature, indentation, narrowing) as well as significant improvement in penile girth in all three cases following the placement of the Penuma® subcutaneous silicone penile prosthesis. The procedure resulted in improved sexual function and satisfactory aesthetic outcomes as reported by patients. No major complications were observed during the follow-up period. Conclusions Our case series demonstrates the potential effectiveness and benefits of using Penuma® to correct residual penile deformity and to provide penile girth enhancement in patients post-PD treatment. At this time, we would consider offering Penuma® implantation when residual curvature is less than 30 degrees and indentation does not cause any instability or hinge-effect during penetrative sexual activity. Further research and larger case studies are warranted to validate these findings and assess long-term outcomes and patient-reported satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: IMD.

Aesthetic Restoration of Severe Hemifacial Atrophy With Free Adipofacial Antero Lateral Thigh Flap Followed by Autologous Fat Grafting; Optimizing Result and Long-Term Outcome.

Hemifacial atrophy (Romberg disease) is characterized by progressive soft tissue and bone atrophy on 1 side of the face. The process of atrophy usually starts in the late first or early second decade of life. Romberg Patients usually require soft tissue augmentation for the correction of their defect. There are many reconstructive tools available to correct such facial asymmetry. In this study, we evaluate the outcome of the free adipofacial flap followed by autologous fat grafting in the treatment of Romberg disease, regarding aesthetics and longevity of the treatment. A retrospective review of 12 patients with moderate to severe hemifacial atrophy from April 2016 till March 2019. All patients received soft tissue augmentation with free adipofascial anterolateral thigh flaps, followed by autologous fat grafting 6 to 12 months later for correction of residual deformity. The average follow-up period was 18 months (range, 6-30). There were 9 females and 3 males in this study. All flaps were survived, and the effect is long-lasting during follow-up. Patients were satisfied with the result especially after refinement of the result of free tissue transfer. The donor sites were closed directly and with no apparent morbidities nor dysfunctions. Microsurgical free tissue transfer is considered a gold standard tool in the management of moderate and severe form of hemifacial atrophy. Among different flaps available, free adipofacial anterolateral thigh flap (ALT) works as a workhorse flap in the correction of a severe form of the disease. Autologous fat grafting is a versatile and reliable option to correct residual deformities. We believed that such a combination is a superb approach to optimize the outcome of the severe form of the progressive hemifacial atrophy.

Reconstruction of Traumatic Defects of the Tibia With Free Fibula Flap and External Fixation.

Traumatic intercalary defects of the tibia may be effectively managed with the free fibula flap. However, any alteration of limb alignment with residual bony angular deformity of the tibia must be also addressed. We describe the use of the free fibula flap in conjunction with external fixation to allow residual deformity correction and patient mobilization ambulation during healing of the free flap. Retrospective medical record review was conducted of patients with segmental tibial defects greater than 7 cm who underwent reconstruction with fibula free flap and simple pin-bar external fixation, followed by conversion to 6-axis computer-assisted multiplanar circular ring external fixation to correct residual bony deformity. Outcomes analyses included free flap complications, return to the operating room, complications associated with the external fixation, bony union, correction of residual deformity, amputation rate, visual analog pain scales, and patient satisfaction. Eight patients (8 tibiae) underwent reconstruction. Mean tibial bone defect was 10.2 cm; all limbs had soft-tissue defects (mean size, 138 cm). Free fibula grafts were harvested as osteocutaneous or osteomyocutaneous flaps (average length, 12 cm). Complications included 1 delayed union and 3 (37.5%) patients readmitted for graft fracture. Ultimately, 100% of patients achieved graft union with satisfactory correction of residual limb deformity. Limb salvage rate was 100%. Management of segmental tibial bone loss utilizing initial simple external fixation and microsurgical reconstruction followed by application of computer-assisted circular external fixator may provide a reliable reconstructive protocol for posttraumatic tibial defects with residual bone malalignment.

Combined technique with hydroxyapatite coated intramedullary nails in treatment of anterolateral bowing of congenital pseudarthrosis of tibia

PurposeThe goal of this study is to evaluate the treatment outcomes of anterolateral bowing and residual deformities of distal tibia in patients with CPT using circular external fixation and hydroxyapatite coated flexible intramedullary nailing without excision of affected part of tibia. Patients and methodsSix patients (4 boys and 2 girls, mean age 12.4 ± 4.1 years) were included in the study. Mean follow-up is 2.1 years. In 4 patients with early onset of disease initial surgical treatment (at age of 5–8 years) was dysplastic zone or pseudarthrosis resection with proximal metaphyseal osteotomy for bone transport. Children with unbroken bowed tibia (2 cases of type II according to Crawford classification) had no previous surgery. Neurofibromatosis type I was diagnosed in 4 cases. Surgical technique for residual deformity correction consisted of percutaneous osteotomy, application of circular external frame and composite hydroxyapatite-coated intramedullary nailing. ResultsMean external fixation time was 95.3 ± 17.5 days. All patients never get fractured after frame removal. At the present time, they are considered to be healed, in 2.1 years, in average, without fractures or deformity recurrence. Mean lower limb length discrepancy varied from 2 to 10 mm at the latest follow-up control. After realignment procedure, patients didn't require additional surgery but one. Intramedullary nails were removed in two years after deformity correction for individual reason. ConclusionCorrection of anterolateral bowing or residual deformity in children with CPT is indicated. Association of external fixation with intramedullary nailing/rodding left in situ after frame removal ensure stability and accuracy of deformity correction. Biological methods of stimulation of bone formation in dysplastic zone are obligatory to ensure bone union. Intramedullary nailing with composite hydroxyapatite-coated surface provides mechanical and biological advantages in patients with CPT.

Transverse debridement and acute shortening followed by distraction histogenesis in the treatment of open tibial fractures with bone and soft tissue loss

This retrospective case series evaluates the technique of transverse debridement, acute shortening and subsequent distraction histogenesis in the management of open tibial fractures with bone and soft tissue loss, thereby avoiding the need for a soft tissue flap to cover the wound. Thirty-one patients with Gustilo grade III open tibial fractures between 2001 and 2011 were initially managed with transverse wound extensions, debridement and shortening to provide bony apposition and allowing primary wound closure without tension, or coverage with mobilization of soft tissue and split skin graft. Temporary monolateral external fixation was used to allow soft tissues resuscitation, followed by Ilizarov frame for definitive fracture stabilization. Leg length discrepancy was corrected by corticotomy and distraction histogenesis. Union was evaluated radiologically and clinically. Patients’ mean age was 37.3 years (18.3–59.3). Mean bone defect was 3.2 cm (1–8 cm). Mean time to union was 40.1 weeks (12.6–80.7 weeks), and median frame index was 75 days/cm. Median lengthening index (time in frame after corticotomy for lengthening) was 63 days/cm. Mean clinic follow-up was 79 weeks (23–174). Six patients had a total of seven complications. Four patients re-fractured after frame removal, one of whom required a second frame. Two patients required a second frame for correction of residual deformity, and one patient developed a stiff non-union which united following a second frame. There were no cases of deep infection. Acute shortening followed by distraction histogenesis is a safe method for the acute treatment of open tibial fractures with bone and soft tissue loss. This method also avoids the cost, logistical issues and morbidity associated with the use of local or free-tissue transfer flaps and has a low rate of serious complications despite the injury severity.

Posterior Versus Three-Column Osteotomy for Late Correction of Residual Coronal Deformity in Patients With Previous Fusions for Idiopathic Scoliosis

Study DesignRetrospective case series. ObjectiveTo compare the early results of posterior column (PCO) and three-column (3CO) osteotomies performed in patients with previously fused idiopathic scoliosis and review their abilities to achieve coronal correction of residual deformities. Summary of Background DataResidual deformity of previously fused AIS can accelerate adjacent segment degeneration secondary to lowest instrumented vertebra (LIV) tilt and rotation. Many of these patients are not satisfied with their cosmetic appearance and would choose revising the deformity when future surgery is indicated. MethodsThe data from 29 consecutive patients who underwent PCOs or 3COs for late revisions of idiopathic scoliosis were reviewed. Measurements included Cobb angle, focal osteotomy angle, and coronal balance. Perioperative data, complications, and patient-reported outcomes were also reviewed. ResultsFourteen patients were treated with PCOs and 15 with 3COs. Global coronal correction was equal between the two groups. In the PCO group, where patients underwent a mean of 2.4 osteotomies, 20.2° of correction was obtained compared to 19.5° in the 3CO group (p = .33), which all underwent single osteotomies. The average coronal correction was 9.2°/osteotomy for the PCO group and 14.1°/osteotomy for the 3CO group (p < .01). Estimated blood loss was 1,417.5 mL in the PCO group compared to 3,199.3 in the 3CO group (p < .01). Five patients (36%) had intraoperative complications in the PCO group compared to 12 (80%) in the 3CO group (p < .05). There were no differences in operative times, length of stay, or patient-reported outcomes between groups. ConclusionPCOs and 3COs performed in patients with previously fused spines for idiopathic scoliosis are effective in achieving residual deformity correction. In cases of posterior fusions, where the patient has a mobile anterior column, PCOs should be considered over 3COs because of their decreased risk of blood loss and complications.

Intra-articular corrective osteotomies combined with the Ilizarov technique for the treatment of deformities of the knee

To present our experience of using a combination of intra-articular osteotomy and external fixation to treat different deformities of the knee. A total of six patients with a mean age of 26.5 years (15 to 50) with an abnormal hemi-joint line convergence angle (HJLCA) and mechanical axis deviation (MAD) were included. Elevation of a tibial hemiplateau or femoral condylar advancement was performed and limb lengthening with correction of residual deformity using a circular or monolateral Ilizarov frame. At a mean follow-up of 2.8 years (1.5 to 4.1), the mean HJLCA improved from 15.6° (10° to 23°) pre-operatively to 0.4° (0° to 2°). The mean MAD improved from 70.0 mm (20.1 to 118.5) pre-operatively to 9.1 mm (3 to 15). The mean tibiofemoral angle improved from 31.0° (8° to 54°) pre-operatively to 4.9° (2° to 8°). The mean limb-length discrepancy decreased from 6.3cm (2.9 to 13.6) pre-operatively to 1.1 cm (0 to 5). All osteotomies and distraction zones healed without complications. The use of intra-articular corrective osteotomies combined with the Ilizarov technique allowed correction of deformities of the knee joint with satisfactory HJLCA and overall mechanical axis in six patients with a good functional and cosmetic outcome in the short term. Cite this article: Bone Joint J 2017;99-B:204-10.

Perthes disease

Morbus Perthes today still poses a challenge for the orthopaedic surgeon because of the unclear aetiology as well as the controversial discussion about the role and kind of multiple treatment principles. The prognosis depends upon clinical (e.g. age at onset, reduction of range of motion, gender) and radiological (extent of necrosis, containment) parameters. Of these, only the reduced range of motion and a loss of containment can be adressed therapeutically, be it in a conservative and/or operative concept. Pelvic osteotomies have the advantage of a high potential of correction without the biomechanic disadvantages which are associated with intertrochanteric varus osteotomies. Nowadays, the use of orthoses is considered to be obsolete. Non-containment is targeted mainly on the symptomatic treatment and the correction of residual deformities. Based on the outcome after the final stage there is a risk of premature osteoarthritis with the need of early total hip replacement.

Taylor Spatial Frame Fixation in Patients With Multiple Traumatic Injuries

To evaluate the Taylor spatial frame (TSF) for primary and definitive fixation of lower limb long-bone fractures in patients with multiple traumatic injuries. Retrospective. Level I trauma center. Consecutive series of 52 patients, 57 fractures (25 femoral and 32 tibial), treated between 2005 and 2009. Forty-nine fractures (86%) were open. Injury Severity Score ≥16 for all patients. Fifty-four fractures (95%) underwent definitive fixation with the TSF and 3 were treated primarily within 48 hours of injury. In 22 cases (39%), fractures were acutely reduced with the TSF, fixed to bone and the struts in sliding mode without further adjustment, and in 35 cases (61%), the total residual deformity correction program was undertaken. Clinical and radiological. Complete union was obtained in 52 fractures (91%) without additional surgery at an average of 29 weeks. Four nonunions and 1 delayed union occurred. Results based on Association for the Study and Application of the Method of Ilizarov criteria: 74% excellent, 16% good, 4% fair, and 7% poor for bone outcomes and 35% excellent, 47% good, and 18% fair for functional outcomes. Eighty-eight percent of patients returned to preinjury work activities. Primary and definitive fixation with the TSF is effective. Advantages include continuity of device until union, reduced risk of infection, early mobilization, restoration of primary defect caused by bone loss, easy and accurate application, convertibility and versatility compared with a monolateral fixator, and improved union rate and range of motion for lower extremity long-bone fractures in patients with multiple traumatic injuries.

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early, although, surprisingly, it is not always necessary. Haemodynamic resuscitation, followed by thorough patient evaluation, is done to rule out concomitant injuries often associated with warfare injuries. They may go unnoticed when attention is directed primarily to an extensive facial injury 4–7 . After early resuscitation, careful history and physical examination and paraclinical diagnostics are necessary for correct management. Craniofacial computed tomography-scans with soft tissue and bone imaging in different views (axial, coronal and three dimensional) are the procedures of choice for diagnosis of facial injuries. Consultation with different specialists is often necessary for treatment. Surgical management of facial gunshot wounds is basically divided into three stages: (1) debridement, fracture stabilisation, and primary closure; (2) reconstruction of hard tissues, provided soft tissue coverage is adequate; and (3) rehabilitation of the oral vestibule, alveolar ridge, and secondary correction of residual deformities and dental implants 6,8 . Herein, we review and evaluate the current trends in the management of maxillofacial gunshot injuries. Discussion The authors have referenced some of their own studies in this review. These referenced studies have been conducted in accordance with the Declaration of Helsinki (1964) and the protocols of these studies have been approved by the relevant ethics committees related to the institution in which they were performed. All human subjects, in these referenced studies, gave informed consent to participate in these studies. Debridement

Surgical TREATMENT of Preschool Children with Congenital Developmental Disorders in the Lumbar Spine

Objective. To assess surgical treatment of children with congenital lumbar spine deformities associated with congenital developmental disorders of vertebrae and to select optimal approach to the treatment of such patients. Material and Methods. We have operated 16 patients aged from one year and 11 months to six years and three months with congenital scoliosis and kyphoscoliosis associated with developmental disorders of the lumbar vertebrae. Orthopedic status and the state of deformed spine before and after surgical intervention were evaluated based on data of clinical, neurological, and radiological examinations. Degree of immediate postoperative correction of congenital deformity and long-term outcomes after metal device removal were assessed. Results. Surgical treatment of patients younger than 3 years of age with isolated hemivertebra in the lumbar spine resulted in up to 86.0 % correction of scoliotic deformity and up to 77.5 % that of kyphotic deformity. The further child’s growth is associated with a tendency toward spontaneous correction of residual deformity. In children of four to seven years old the mean correction of scoliosis reached 80.0 %, and that of kyphosis – 87.5 %. The loss of correction was not observed during a short-time follow-up period. Conclusion. The optimal age for surgical treatment of congenital deformity in developmental vertebral disorders is the age below 3 years. Deformity correction at this age can provide a maximum approach of frontal and sagittal contours to their physiological norms.

No difference in tibial lengthening index by use of Taylor Spatial Frame or Ilizarov external fixator

Background Different methods and devices are used to perform lengthening and deformity reconstruction in the tibia. Recently, the Taylor spatial frame (TSF) has been introduced as a computer-assisted and versatile external ring fixator. Lengthening index (LI) and complications are important result parameters, and the aim of this study was to review our first 20 tibial segments operated with the TSF and to compare the results with our experience of using the traditional Ilizarov external fixator (IEF).Patients and methods We lengthened 20 tibial segments in 20 patients with the TSF. The results were compared with those of 27 tibial segments from 27 patients that were lengthened with the IEF. All segments were operated on with monofocal osteotomies.Results In the overlapping zone of comparable lengthening distances between 2.4 and 6.0 cm, the LI of 2.4 and 1.8 months/cm was not significantly different between the TSF and IEF groups, respectively (p = 0.17). This non-significant difference was confirmed after adjustment for age.Interpretation We found no difference between the TSF and IEF frames regarding LI and complication rate. However, rotational, translational, and residual deformity correction is easier to perform with the TSF.

Cleft Lip Residual Deformity Correction

AbstractCleft lip residual deformities need a Careful assessment of disfigurement and distortion related defects.Lip and nose both develop them after the successful primary repair. That of nose are related to collumela, alar cartilages, septum both bony as well as cartilagenous and vestibules. Surgical correction of each and every one of the defects present is expected to give a functionally and aesthetically acceptable result. Proper understanding of skeletal structural support of nose and that of certain other elements on which nose skin is draped is necessary. This artical deals with finer aspects of deformities that develop in cleft lip noses and describes ways and means of correcting them.

Correction of Residual Deformities of the Lip and Nose in Repaired Clefts of the Primary Palate (Lip and Alveolus)

Residual deformities of the lip and nose in individuals with repaired unilateral and bilateral clefts may very in severity depending on the state of the original defect, the care taken in the initial surgical procedure, the pattern of the patient's facial growth, and the effectiveness of interceptive orthodontic techniques. Because each patient has a unique combination of deformities, their surgical reconstruction usually requires the modification and combination of several surgical techniques. In this article, a summary of various reconstructive techniques is presented, beginning with an evaluation of secondary cleft defects.

14 Delayed Occlusal and Maxillofacial Deformities after Trauma

Certain unique problems are involved in the surgical correction of residual deformities that have been caused by trauma. These deformities include poorly occluding teeth, facial or jaw asymmetry, and limited jaw opening, and may result in a limited ability to chew, altered speech, and emotional and social problems. Osteotomy may be used to reposition malunited parts; prosthetic devices can aid movement of bony parts and help to achieve an optimal result. Certain unique problems are involved in the surgical correction of residual deformities that have been caused by trauma. These deformities include poorly occluding teeth, facial or jaw asymmetry, and limited jaw opening, and may result in a limited ability to chew, altered speech, and emotional and social problems. Osteotomy may be used to reposition malunited parts; prosthetic devices can aid movement of bony parts and help to achieve an optimal result.